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analyses,6 priority should be given to specific types of job. For example, priority should be given to: ■ Jobs with high assault rates due to workplace violence; ■ Jobs that are new to an operation or have undergone procedural changes that may increase the potential for workplace violence; and ■ Jobs that require written instructions, such as procedures for administering medicine, and steps required for transferring patients. After an incident or near miss, the analysis should focus on: ■ Analyzing those positions that were affected; ■ Identifying if existing procedures and operations were followed and if not, why not (in some instances, not following procedures could result in more effective protections); ■ Identifying if staff were adequately qualified and/or trained for the tasks required; and ■ Developing, if necessary, new procedures and operations to improve staff safety and security. Employee surveys Employee questionnaires or surveys are effective ways for employers to identify potential hazards that may lead to violent incidents, identify the types of problems workers face in their daily activities, and assess the effects of changes in 6 OSHA 3071-2002 (Revised). Job Hazard Analysis. Occupational Safety and Health Administration 1 2 work processes. Detailed baseline screening surveys can help pinpoint tasks that put workers at risk. Periodic surveys— conducted at least annually or whenever operations change or incidents of workplace violence occur—help identify new or previously unnoticed risk factors and deficiencies or failures in work practices. The periodic review process should also include feedback and follow-up. The following are sample questions: ■ What daily activities, if any, expose you to the greatest risk of violence? ■ What, if any, work activities make you feel unprepared to respond to a violent action? ■ Can you recommend any changes or additions to the workplace violence prevention training you received? ■ Can you describe how a change in a patient’s daily routine affected the precautions you take to address the potential for workplace violence? Client/Patient Surveys Clients and patients may also have valuable feedback that may enable those being served by the facility to provide useful information to design, implement, and evaluate the program. Clients and patients may be able to participate in identifying triggers to violence, daily activities that may lead to violence, and effective responses. 3. Hazard Prevention and Control After the systematic worksite analysis is complete, the employer should take the appropriate steps to prevent or control the hazards that were identified. To do this, the employer should: (1) identify and evaluate control options for workplace hazards; (2) select effective and feasible controls to eliminate or reduce hazards; (3) implement these controls in the workplace; (4) follow up to confirm that these controls are being used and maintained properly; and (5) evaluate the effectiveness of controls and improve, expand, or update them as needed. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers 1 3 In the field of industrial hygiene, these steps are generally categorized, in order of effectiveness, as (1) substitution; (2) engineering controls; and (3) administrative and work practice controls. These principles, which are described in more detail below, can also be applied to the field of workplace violence. In addition, employers should ensure that, if an incident of workplace violence occurs, post-incident procedures and services are in place and/or immediately made available. Substitution The best way to eliminate a hazard is to eliminate it or substitute a safer work practice. While these substitutions may be difficult in the therapeutic healthcare environment, an example may be transferring a client or patient to a more appropriate facility if the client has a history of violent behavior that may not be appropriate in a less secure therapeutic environment. Engineering controls and workplace adaptations to minimize risk Engineering controls are physical changes that either remove the hazard from the workplace or create a barrier between the worker and the hazard. In facilities where it is appropriate, there are several